Mitral regurgitation differential diagnosis: Difference between revisions
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==Common Causes of Mitral Regurgitation== | |||
===Chronic Mitral Regurgitation=== | |||
The most common cause of mitral regurgitation is [[mitral valve prolapse]] (MVP), which in turn is caused by [[myxomatous degeneration]].<ref name='MedicineNetMVP-Kulick'>{{cite web|url=http://www.medicinenet.com/mitral_valve_prolapse/article.htm |title=Mitral Valve Prolapse (MVP) |accessdate=2010-01-18 |last=Kulick |first=Daniel |work=MedicineNet.com |publisher=MedicineNet, Inc }}</ref> The most common cause of primary mitral regurgitation in the [[United States]] (causing about 50% of primary mitral regurgitation) is [[myxomatous degeneration]] of the valve. Myxomatous degeneration of the mitral valve is more common in females, and is more common in advancing age. This causes a stretching out of the leaflets of the valve and the [[chordae tendineae]]. The elongation of the valve leaflets and the chordae tendineae prevent the valve leaflets from fully coapting when the valve is closed, causing the valve leaflets to prolapse into the left atrium, thereby causing mitral regurgitation. | |||
[[Ischemic heart disease]] causes mitral regurgitation by the combination of ischemic dysfunction of the [[papillary muscles]], and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valve annulus. | |||
[[Rheumatic fever]] and [[Marfan's syndrome]] are other typical causes of mitral regurgitation.<ref name=agabegi2nd-ch1/> | |||
'''Secondary mitral regurgitation''' is due to the dilatation of the [[left ventricle]], causing stretching of the mitral valve annulus and displacement of the papillary muscles. This dilatation of the left ventricle can be due to any cause of [[dilated cardiomyopathy]], including [[aortic insufficiency]], nonischemic dilated [[cardiomyopathy]] and [[Noncompaction Cardiomyopathy]]. It is also called '''functional mitral regurgitation''', because the papillary muscles, chordae, and valve leaflets are usually normal.<ref>[http://www.uptodate.com/patients/content/topic.do?topicKey=~Ux3kbGWsXmiaqiH Functional mitral regurgitation] By William H Gaasch, MD. Retrieved on Jul 8, 2010</ref> | |||
===Acute Mitral Regurgitation=== | |||
# Acute bacterial [[endocarditis]]. The predominant organism is ''[[Staphylococcus aureus|S. aureus]]'', but varies depending upon the patient.<ref name=agabegi2nd-ch1>{{cite book |author=Elizabeth D Agabegi; Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages= |isbn=0-7817-7153-6 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease</ref> | |||
#[[Papillary muscle]] rupture or dysfunction,<ref name=agabegi2nd-ch1/> associated with [[ST elevation myocardial infarction]] | |||
== Full Differential Diagnosis of Causes of Mitral Regurgitaion== | == Full Differential Diagnosis of Causes of Mitral Regurgitaion== | ||
Revision as of 23:24, 26 February 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Common Causes of Mitral Regurgitation
Chronic Mitral Regurgitation
The most common cause of mitral regurgitation is mitral valve prolapse (MVP), which in turn is caused by myxomatous degeneration.[1] The most common cause of primary mitral regurgitation in the United States (causing about 50% of primary mitral regurgitation) is myxomatous degeneration of the valve. Myxomatous degeneration of the mitral valve is more common in females, and is more common in advancing age. This causes a stretching out of the leaflets of the valve and the chordae tendineae. The elongation of the valve leaflets and the chordae tendineae prevent the valve leaflets from fully coapting when the valve is closed, causing the valve leaflets to prolapse into the left atrium, thereby causing mitral regurgitation.
Ischemic heart disease causes mitral regurgitation by the combination of ischemic dysfunction of the papillary muscles, and the dilatation of the left ventricle that is present in ischemic heart disease, with the subsequent displacement of the papillary muscles and the dilatation of the mitral valve annulus.
Rheumatic fever and Marfan's syndrome are other typical causes of mitral regurgitation.[2]
Secondary mitral regurgitation is due to the dilatation of the left ventricle, causing stretching of the mitral valve annulus and displacement of the papillary muscles. This dilatation of the left ventricle can be due to any cause of dilated cardiomyopathy, including aortic insufficiency, nonischemic dilated cardiomyopathy and Noncompaction Cardiomyopathy. It is also called functional mitral regurgitation, because the papillary muscles, chordae, and valve leaflets are usually normal.[3]
Acute Mitral Regurgitation
- Acute bacterial endocarditis. The predominant organism is S. aureus, but varies depending upon the patient.[2]
- Papillary muscle rupture or dysfunction,[2] associated with ST elevation myocardial infarction
Full Differential Diagnosis of Causes of Mitral Regurgitaion
Listed alphabetically:
- Amyloid[4]
- Cardiomyopathy
- Coronary Heart Disease
- Congenital mitral regurgitation
- Ehlers-Danlos Syndrome
- Heart Failure
- Hypertrophic obstructive cardiomyopathy
- Infective endocarditis
- Left ventricular dilation
- Marfan Syndrome
- Mitral annular calcification
- Mitral valve prolapse
- Myocardial Infarction
- Myocardial ischemia
- Myxomatous degeneration
- Osteogenesis imperfecta
- Prosthetic valve dysfunction
- Rheumatic Heart Disease
- Syphilis if left untreated
- Systemic Lupus Erythematosus
- Trauma
Complete Differential Diagnosis of the Causes of ...
(By organ system)
| Cardiovascular | | Cardiomyopathy | Coronary Heart Disease |Congenital mitral regurgitation | Dilation of Mitral annulus due to Heart Failure | Hypertrophic obstructive cardiomyopathy | Infective endocarditis | Left ventricular dilation | Mitral annular calcification | Mitral valve prolapse | Myocardial Infarction | Myocardial ischemia | Myxomatous degeneration | Prosthetic valve dysfunction |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | Ehlers-Danlos Syndrome | Marfan Syndrome | Osteogenesis imperfecta |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Endocarditis most often due to Staphylococcus aureus [2] | Syphilis |
| Musculoskeletal / Ortho | Infective endocarditis |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | Amyloid | Ehlers-Danlos Syndrome Rheumatic Heart Disease | Systemic Lupus Erythematosus |
| Sexual | No underlying causes |
| Trauma | Trauma and motor vehicle accident |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
- ↑ Kulick, Daniel. "Mitral Valve Prolapse (MVP)". MedicineNet.com. MedicineNet, Inc. Retrieved 2010-01-18.
- ↑ 2.0 2.1 2.2 2.3 Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6. Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease
- ↑ Functional mitral regurgitation By William H Gaasch, MD. Retrieved on Jul 8, 2010
- ↑ British Medical Journal case reports; doi:10.1136/bcr.08.2008.0821